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PubMed2002

Epidemiology of neonatal meningitis in Qatar.

OBJECTIVE: Neonatal meningitis is responsible for thousands of neonatal deaths annually all over the world. Our study was conducted to determine the epidemiology, management and best preventive measures for neonatal meningitis in Qatar. METHODS: A retrospective study reviewed the records of bacterial meningitis patients under the age of one month. The study was carried out at Hamad Medical Hospital, the only hospital that provides health care at Qatar and the study period was between January 1998 to December 2000. RESULTS: Thirteen patients were included. Sixty percent of patients had early onset meningitis. Causative organisms were group B Streptococcus pneumoniae, Klebsiella pneumonia, Pseudomonas species, Neisseria meningitidis, Staphylococcus epidermidis and Flavibacterium meningococcus septicum. A bacterial resistance to the usual combination of ampicillin and gentamicin were noticed (as initial treatment before culture sensitivity results), which affected negatively on some patients. Complications of cerebral palsy, mental retardation and epilepsy occurred in 3 patients (23%). None of the patients died during the study period. CONCLUSION: Emphasis is placed on the importance of correct early diagnosis and appropriate antibiotic therapy. It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis.

Anti-Bacterial Agents↗
PubMed2004

[Antigen properties of oral intake whole-culture preparations from Neisseria meningitides of serogroups A, B and C].

A new technology of deriving the whole-culture peroral meningococcal mono-vaccines of serogroups A, B and C from the acetone-inactivated cultures was experimentally substantiated. The latter cultures were obtained through computer-aided continuous-flow cultivation of Neisseria meningitides of the above serogroups in the bioreactor with a synthetic nutrient medium. The whole-culture meningococcal mono-preparation of 3 serogroups comprised a complete set of antibodies, i.e. polysaccharides (PS), external membrane proteins (EMP) and lipopolysaccharides (LPP), in their native condition. High levels of IgG to PS, EMP and LPP were detected in blood sera of rabbits, which had been perorally immunized by the above preparations; such high levels persisted for a long time (303 days--observation period). It is noteworthy, that in accumulating of IgG to all investigated antigens of meningococcus of serogroups A and C, the optimal doses of whole-culture peroral monovaccines did not exceed the culture doses used to derive the hyper-immune sera at intravenous immunization.

Administration, Oral↗
PubMed2005

Molecular epidemiology of meningococci isolated in Niger in 2003 shows serogroup A sequence type (ST)-7 and serogroup W135 ST-11 or ST-2881 strains.

In 2003, in the Zinder and Maradi regions (Niger), epidemics were due to serogroup A:4:P1.9 meningococci belonging to sequence type 7 (ST-7). In Niamey, only sporadic cases were reported: 55% of the meningococcus strains were in serogroup A, and 38% were in serogroup W135 and could be placed in ST-11, identical to the 2002 Burkina Faso epidemic clone, and in ST-2881, a new ST.

Electrophoresis, Gel, Pulsed-Field↗
PubMed1993

[Increased incidence of invasive meningococcal disease caused by C:2a:P1.2 meningococci in certain regions of the Czech Republic].

In the first half of 1993 an increased incidence of invasive meningococcal disease was recorded in the Czech Republic. In the CR a total of 59 cases were revealed, incl. 10 fatal ones. This high lethality (16.9%) is markedly higher than that from 036 recorded in this country during previous years. The highest incidence and death rate was recorded in the North Moravian region and in the age group from 15-19 years. Based on active surveillance of the invasive meningococcal disease by epidemiologists, microbiologists and infectiologists of the entire Czech Republic, it may be concluded that the sulphonamide sensitive strain Neisseria meningitidis C:2a:P1.2 caused in the North Moravian region a local epidemic of invasive meningococcal disease in the army and civilian population. In other regions of the CR the epidemiological situation in the first half of 1993 did not differ from the previous period: sporadic incidence of meningococcal disease, prevalence of the serological group B, highest incidence in the youngest age groups. The meningococcus C:2a:P1.2 was not detected in the CR before 1993. This uncommon epidemiological situation was resolved by immunization, aimed from the antigenic aspect and with regard to age and locality.

Adolescent↗
PubMed2002

Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis.

Ceftriaxone is recommended in children with acute bacterial meningitis (ABM) for 10 days. However, the drug is expensive, and shorter duration of therapy, if equally effective, would cut costs of therapy and hospitalization. The aim of this study was to compare the outcome of 7 days vs. 10 days' ceftriaxone therapy in children with ABM. Seventy-three children aged 3 months to 12 years with ABM, consecutively admitted to hospital were enrolled. Ceftriaxone was given for 7 days to all. Randomization to group I (7 days) and group II (10 days) therapy was done on the seventh day. At the end of 7 days' therapy in group I and 10 days in group II, children were evaluated using a clinical scoring system. Children with a score of more than 10 were labelled as 'treatment failures' and were continued on ceftriaxone. If a score was less than 10, the antibiotic was stopped. Complications were appropriately evaluated and managed. All children were followed-up 1 month after discharge: neurodevelopmental assessment, Denver Development Screening Tests, IQ and hearing assessment were done. After excluding four patients, there were 35 children in group I and 34 in group II. The two groups were comparable with respect to age, sex, nutritional status, presenting clinical features, and CSF parameters. Organism identification was possible in 38 per cent of children: (Streptococcus pneumoniae, 21 per cent; Haemophilus influenzae, 13 per cent; meningococcus, 4 per cent). Treatment failure rate was comparable in both groups (9 in group I and 8 in group II) as was the sequelae at discharge and at 1 month (9 in group I, 15 in group II,p > 0.1). Status epilepticus and focal deficits at presentation were significantly associated with treatment failures and sequelae in both the groups (p < 0.05). Length of hospital stay was shorter in group I (10.8 +/- 6.0 days) as compared with group II (14.4 +/- 7.2 days,p < 0.05) and frequency of nosocomial infection was significantly more in group II (p < 0.05). It was concluded that clinical outcome of patients treated with 7 days' ceftriaxone therapy is similar to that of 10 days' therapy, and is associated with lesser nosocomial infection and earlier hospital discharge. Seven days ceftriaxone therapy may be recommended for uncomplicated ABM in children in developing countries.

Ceftriaxone↗
PubMed2005

Vaccines against bacterial meningitis.

Meningitis remains an important cause of morbidity and mortality among children >5 years of age and is especially prevalent in developing countries. Effective routine immunization against Hib, pneumococcus and serogroupC meningococcus has had a significant impact on both invasive disease and carriage caused by these encapsulated bacteria. The major challenge in prevention of meningitis remains the delivery of vaccines worldwide, especially to resource-poor regions with the greatest disease burden.

Bacterial Proteins↗
PubMedDate not supplied

Epidemic meningococcal disease: synthesis of a hypothetical immunoepidemiologic model.

A hypothetical model of the epidermic behavior of Neisseria meningitidis, based upon the induction of susceptibility to disseminated disease by circulating IgA, is presented. The model is based on the assumption that epidemic susceptibility is acquired as a result of induction of serum IgA by cross-reacting enteric bacteria, the priming organism. Co-colonization with the appropriate strain of N. meningitidis then may result in disseminated disease. Colonization by either bacterium in the absence of the other results in reinforcement of the commensal relationship. Slow, silent, fecal-oral transmission of the priming organism determines the time/space characteristics of an epidemic; interruption of fecal-oral transmission aborts it. Aerosol transmission of the meningococcus determines the magnitude of an epidemic. Independent, age-related acquisition of both capsular polysaccharide and lipopolysaccharide antibodies provides immunity in the absence of aberrantly high levels of co-specific serum IgA.

Adolescent↗
PubMed1992

Induction of protective immunity in mice using a 62-kDa recombinant fragment of a Schistosoma mansoni surface antigen.

Mice exposed to radiation-attenuated cercariae of Schistosoma mansoni are highly resistant to challenge infection, and sera from these mice can confer partial resistance when transferred to naive recipients. These sera recognize Ag present in schistosomular and adult worms, among them an Ag of 200 kDa. A cDNA encoding a 62-kDa portion of this Ag was cloned; the deduced amino acid sequence of this cDNA clone shares homology with myosins of other species. To assess the immunoprophylactic potential, we carried out vaccination trials in mice using the recombinant polypeptide expressed as a fusion protein with beta-galactosidase presented in the form of proteosome complexes with the outer membrane protein of meningococcus. The level of protection achieved was 32%, and this level could be increased to 75% by removal of those amino acids included in the fusion protein that were derived from the vector to yield a polypeptide, designated rIrV-5. A similar level of protection was achieved when mice were immunized with the same dose of rIrV-5 in the form of protein complexes but without outer membrane protein, suggesting that protection did not require the use of adjuvant. However, at least three immunizations were necessary to achieve protection. Using mAb and sera from mice vaccinated with rIrV-5, we demonstrated that the native protein recognized by antibodies against rIrV-5 is a 200-kDa protein that is expressed on the surface of newly transformed schistosomula. The protection achieved with rIrV-5 in mice encourages additional studies of its potential as a vaccine candidate for the prevention of schistosomiasis.

Amino Acid Sequence↗
PubMed1997

A week in the life of a travel clinic.

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.

Adolescent↗
PubMed1992

Neonatal meningococcal conjunctivitis associated with meningococcal meningitis.

Two infants are described in whom identical strains of meningococcus were isolated from both the eyes and the cerebrospinal fluid. This suggests that the eye may be a portal of entry in at least some cases of perinatally acquired neonatal meningococcal disease and has important implications for the management of purulent conjunctivitis in the newborn.

Conjunctivitis, Bacterial↗
PubMed1969

Human immunity to the meningococcus. II. Development of natural immunity.

Results of the present study suggest that natural immunity to meningococcal disease is initiated, reinforced, and broadened by intermittent carriage of different strains of meningococci throughout life. In young adults, carriage of meningococci in the nasopharynx is an efficient process of immune sensitization. 92% of carriers of serogroup B, C, or Bo meningococci were found to develop increased titers of serum bactericidal activity to their own meningococcal isolate, and 87% developed bactericidal activity to heterologous strains of pathogenic meningococci. The rise in bactericidal titer occurred within 2 wk of onset of the carrier state, and was accompanied by an increase in titer of specific IgG, IgM, and IgA antibodies to meningococci. In early childhood, when few children have antibodies to pathogenic meningococci, active immunization seems to occur as a result of carriage of atypical, nonpathogenic strains. Immunity to systemic meningococcal infection among infants in the neonatal period is associated with the passive transfer of IgG antibodies from mother to fetus. The antigenic determinants which initiate the immune response to meningococci include the group-specific C polysaccharide, cross-reactive antigens, and type-specific antigens.

Adolescent↗
PubMed2001

Exploring the evolution of diversity in pathogen populations.

Pathogen biodiversity is an under-exploited source of inference regarding disease processes and the evolution of pathogens and pathogenesis. In addition, the structure of pathogen populations, especially for diverse organisms such as the meningococcus, has implications for public health interventions including vaccination and antibiotic use. The predominant paradigm for interpreting bacterial diversity has been the clonal population structure, which has been modified by the incorporation of the effects of horizontal genetic exchange. Multilocus models of variable antigens, which explore the effects of immune selection, provide alternative explanations for structured diversity in pathogen populations.

Antigenic Variation↗
PubMed1969

Human immunity to the meningococcus. I. The role of humoral antibodies.

Susceptibility to systemic meningococcal disease is related to a selective deficiency of humoral antibodies to pathogenic strains of meningococci. In a study of the age-specific incidence of meningococcal meningitis in the United States, it was found that the proportion of individuals with serum bactericidal activity to meningococci of serogroups A, B, and C was reciprocally related to the incidence of disease. The prevalence of bactericidal activity was highest at birth and among adults, and lowest in infants between 6 and 24 months of age. Sera from 51 of 54 prospective cases of meningococcal disease among military recruits were deficient in antibodies to homologous and heterologous strains of pathogenic meningococci as determined by serum bactericidal activity and indirect immunofluorescence. Such sera, however, could support the bactericidal activity of purified human gamma globulin (Cohn fraction II), and such individuals could respond immunologically to infection with meningococci. The implication is that susceptible persons are deficient in antimeningococcal antibodies because they have not received significant exposure to meningococcal antigens in the past. The fate of individuals who lack bactericidal antibodies to pathogenic meningococci was determined during an outbreak of group C meningitis among military recruits. The incidence of disease was found to be primarily associated with the incidence of exposure of susceptibles to the pathogenic strains. Whereas 81.5% of the presumed susceptibles acquired a meningococcal strain, only 24.1% acquired an organism similar to the prevalent disease-producing strains. Of the exposed susceptibles, 38.5% developed systemic meningococcal disease.

Adolescent↗
PubMed1987

Benign meningococcemia with IgG and IgM antimeningococcal antibodies measured by ELISA.

Six patients with benign meningococcemia are presented. The clinical picture was typically intermittent fever with chills, skin eruptions, maculopapules (often hemorrhagic) and arthritis/arthralgia in a person in good general condition. Meningococci of serogroup B were isolated from the blood of 3 patients, from the cerebrospinal fluid of 1 patient and from the nasopharynx of the remaining 2 patients. In 4 patients we assayed the levels of IgG and IgM antibodies against meningococcus serogroup B in an enzyme-linked immunosorbent test (ELISA), using whole bacteria as the antigen. All of them had higher antibody levels than the geometric means for healthy controls of both IgG and IgM, except for 1 patient who did not develop IgG antibodies.

Adolescent↗
PubMed2006

[Meningococcus endophthalmitis without meningitidis].

Meningococcus endophthalmitis is exceptional. We report a case of ocular damage following type C meningococcus septicemia with no meningitis. A 20-year-old man reported to the emergency unit for polyarthritis pain in various joints, associated with chills, nausea, and diarrhea without fever. Ophthalmological examination revealed uveitis. A few days later, endogenous endophthalmitis was suggested because of a worsening general condition and fever spells to 39 degrees C. A hemoculture sampled on the patient's admission 4 days earlier revealed Neisseria meningitidis positivity. Meningococcus septicemia with no meningitis was diagnosed. Before the introduction of antibiotics, meningococcus meningitis was unfortunately frequent and ocular septic embolism was not a rare occurrence. The diagnosis of meningococcemia was delayed in our patient because of the atypical symptomatology and ocular manifestations in the forefront. As with any endogenous endophthalmitis, prognosis is bleak and it should be raised whenever suspected uveitis does not react to standard treatment.

Adult↗
PubMed2001

Acute cellulitis: an unusual manifestation of meningococcal disease.

We describe 2 patients who both developed cellulitis due to Neisseria meningitidis and review 8 other cases reported since 1966. Female patients outnumbered male patients by 8 to 2, and there were 5 children and 5 adults. Four cases were caused by the serogroup C meningococcus, 2 cases by serogroup B and 2 others by serogroup Y (the nature of the meningococcal group was not available in 2 cases). Diverse medical underlying conditions were present in 4 of the adult patients. The periorbital region (in all 5 children), limb (in 3 adults), neck (in 1 adult) and face and neck (in 1 adult) were the locations of the meningococcal cellulitis. In all 10 patients, a favorable clinical response to the antibiotic therapy was documented and no relapses occurred. These cases indicate that N. meningitidis should be considered as a causative agent of cellulitis in the appropriate clinical setting, particularly in children with signs of periorbital infection or adults with underlying diseases.

Acute Disease↗
PubMed2003

Rational antibacterial vaccine design through genomic technologies.

After 200 years of practice, vaccinology has proved to be very effective in preventing infectious diseases. However, several human and animal pathogens exist for which vaccines have not yet been discovered. As for other fields of medical sciences, it is expected that vaccinology will greatly benefit from the emerging genomics technologies such as bioinformatics, proteomics and DNA microarrays. In this review, the potential of these technologies will be illustrated taking into account part of the research activities currently in progress in our laboratories. In particular, I will describe the identification of new vaccine candidates against Meningococcus B through high-throughput cloning and expression of meningococcal antigens selected by: (i) in silico analysis of genome sequence; and (ii) transcriptome analysis of bacteria adherent to epithelial cells. In addition, I will show how the combination of high-throughput cloning and expression technology with two-dimensional gel/mass spectrometry led us to the elucidation of Chlamydia pneumoniae surface protein subproteome and to the identification of potential vaccine candidates.

Animals↗